Timing of carotid endarterectomy after acute stroke.
An arbitrary delay of at least 6 weeks before performing carotid endarterectomy after acute stroke has been recommended based on anecdotal reports. This prolonged interval may increase the danger of recurrent neurologic deficit before surgery. From September 1978 to September 1988, carotid endarterectomy was performed on 140 patients at variable intervals after stroke. Eleven patients had temporary stroke, which left 129 patients with neurologic symptoms that persisted for 3 weeks or had a cortical infarct on CT scanning. A prospective therapeutic protocol was applied to 82 patients admitted with acute stroke. They were observed until neurologic recovery reached a plateau, based on clinical observation by a neurologist, before performing angiography and carotid endarterectomy (group I). Forty-seven patients were not seen until after recovery from stroke was established (group II). At initial presentation, the severity of neurologic deficit was classified as mild, moderate, or severe in 31%, 58%, and 11%, respectively. Recovery before operation was registered as complete in 11%, mild residual in 66%, moderate residual in 21%, and severe residual in 2%. Group I patients (n = 82, 64%) were operated on within 6 weeks of stroke and group II (n = 47, 36%) were operated on at varying times after 6 weeks. No significant difference was found in the incidence of cerebrovascular events (1.2% vs 4.2%) and deaths (1.3% vs 2.1%) between groups I and II with respect to the timing of carotid endarterectomy, and no significant difference was found between patients operated on at 2, 4, 6, or more than 6 weeks after stroke.(ABSTRACT TRUNCATED AT 250 WORDS)
Piotrowski
J J
JJ
University of Arizona Health Sciences Center, Section of Vascular Surgery, Tucson 85724.
Bernhard
V M
VM
Rubin
J R
JR
McIntyre
K E
KE
Malone
J M
JM
Parent
F N
FN
Hunter
G C
GC
D000208:Acute Disease; D000368:Aged; D002339:Carotid Arteries / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D011183:Postoperative Complications; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors